 Ki H. Oh, M.D., FACS.
Thomas Hirai, M.D.
200 S 333rd St., Suite 150
Federal Way, WA 98003
Phone: 253-275-6030
Fax: 253-946-0428
Clinic Manager: Ginger Rhodes
Frequently Asked Questions
Surgery assessment:
What are the routine tests before surgery?
What is the purpose of all these tests?
Why do I have to have a GI evaluation?
Why do I have to have a psychiatric evaluation?
Surgery:
Does laparoscopic surgery decrease the risk?
How long does surgery last?
Will I have a lot of pain?
How long do I have to stay in the hospital?
Do you use a drain?
How soon will I be able to walk?
How soon can I drive?
When can I leave the area?
Post Surgery:
Why can't I eat red meat after surgery?
What is dumping syndrome?
What is the problem with milk products?
What do I do to use the gastric bypass "tool" successfully?
Why can't I snack between meals?
Why drink so much water?
Why is exercise important?
Surgery Assessment:
What are the routine tests before surgery?
We always do a number of tests to identify potential problems prior to surgery. These tests include:
- a thorough blood work up and urinalysis to give us a readout of about 20 blood chemistry values,
- chest electrocardiogram (EKG),
- an abdominal ultrasound to look for abnormalities of the ovaries or uterus (female) and/or gallbladder (to check for gall stones),
- pulmonary function testing,
- GI evaluation (EGD),
- clearance from an Internist,
- cardiology evaluation,
- and pulmonary evaluation.
Additional testing outside of these may be required if your medical history indicates the need.
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What is the purpose of all these tests?
Primarily, we need an accurate assessment of your health before undertaking a big operation. The best way to treat a complication is never to have it in the first place, due to advance knowledge. We want to know if your thyroid function is adequate (hypothyroidism can lead to sudden death post-operatively), if you are diabetic (we will have to take special steps to control your blood sugar) and if your heart is sound (surgery increases cardiac stress). We look for signs of liver malfunction, breathing difficulties, excess fluid in tissue, abnormalities of the glands and mineral in body fluids and abnormal blood fat levels.
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Why do I have to have a GI evaluation?
Patients who have significant gastrointestinal (GI) symptoms such as upper abdominal pain, heartburn or belching sour fluid may have serious underlying problems such as hiatal hernia, gastroesophagael reflux or a peptic ulcer. For example, many patients have symptoms of reflux. We know that up to 15 percent of these patients may have changes in the lining of their esophagus, which could predispose to cancer. When our physicians detect GI symptoms on your preliminary evaluation, we ask that you have an evaluation prior to surgery, so that we can take care of them at the same time to avoid complications at surgery.
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Why do I have to have a psychiatric evaluation?
The most common reason is that your insurance company requires it. It is also important to recognize that weight loss surgery is a major, life-changing decision and requires a lifetime of commitment to basic nutritional principals. A psychiatric evaluation can help assess your understanding and knowledge and the ability to follow the basic recovery plan. Few people are disqualified by the psych evaluation.
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Surgery:
Does laparoscopic surgery decrease the risk?
No. Laparoscopic operations carry the same risk as the similar procedure performed as an open operation. The benefits of laparoscopy are typically less discomfort, shorter hospital stay, earlier return to work and much-reduced scarring.
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How long does surgery last?
Typically, the gastric bypass surgery will require 2-3 hours of total time in the operating room.
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Will I have a lot of pain?
We work actively to control pain after surgery. This makes it possible for you to get up and move around soon after surgery, which is very important to reduce complications and hasten healing. Most of our patients are pleasantly surprised how little discomfort they experience.
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How long do I have to stay in the hospital?
You will remain in the hospital as long as it takes to become self-sufficient. Typically, the hospital stay (including the day of the surgery) is two days for laparoscopic gastric band and three days for open gastric bypass.
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Do you use a drain?
Most patients will have a small tube to allow drainage of accumulated fluid from the abdomen. This is a safety measure and the drain can be removed a few days after the surgery. It produces no more than minor discomfort.
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How soon will I be able to walk?
Patients walk or stand at their bedside on the night of the surgery and take several walks the next day and thereafter. On leaving the hospital, you will be able to care for all your personal needs, but will need help with shopping and with transportation.
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How soon can I drive?
We recommend that you do not drive until you have stopped taking narcotic medications and can move quickly and alertly to stop your car, especially in an emergency.
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When can I leave the area?
Patients who come from outside the Seattle/Tacoma area are required to remain in the vicinity for at least one week after the day of surgery. There are important educational sessions, as well as post-operative care, that must be done during this time. Most patients stay at a nearby hotel or with friends or relatives.
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Post Surgery:
Why can't I eat red meat after surgery?
You can, but you will need to be very careful. We recommend that you avoid it for the first several months. Red meats contain a high level of meat fibers, which hold the piece of meat together, preventing you from separating it into small parts when you chew. It can plug the outlet of your stomach pouch and prevent anything from passing through.
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What is dumping syndrome?
Dumping syndrome is caused by consuming sugar or sugar products on an empty stomach. These substances produce a high osmotic load. Your body handles this by diluting the food with particles of water, which reduces blood volume and causes a shock-like state. Sugar may also induce shock due to the altered physiology of your intestinal tract. The result is a very unpleasant feeling, as if you are breaking out in a cold and clammy sweat. You may turn pale, have butterflies in your stomach and a pounding pulse. These symptoms may be followed by cramps and/or diarrhea lasting for 30-60 minutes. Most people have to lie down until it goes away. It can be avoided by not eating the foods which cause it, especially on an empty stomach.
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What is the problem with milk products?
Milk contains a special sugar called lactose (milk sugar), which is not digested well. This sugar passes through undigested until bacteria in the lower bowel acts on it, producing irritating byproducts, as well as gas. Depending on the individual tolerance, some persons find even the smallest amount of milk or milk sugar will cause cramps, gas and diarrhea.
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What do I do to use the gastric bypass "tool" successfully?
The basic rules are simple and easy to follow:
• Eat 4-6 meals per day and no more. Protein, in the form of lean meats (chicken, turkey and fish) and other low-fat sources should be eaten first and should comprise at least half of the volume of the meal eaten. Foods should be cooked without fat. Avoid sauces, gravies, butter, margarine, mayonnaise and junk food.
• Never eat between meals.
• Drink 2-3 quarts or more of water each day. Water must be consumed slowly, 1-2 mouthfuls at a time, due to the restrictive effect of the operation.
• Exercise aerobically every day for at least 20 minutes. We encourage weight/resistance exercise 3-4 days per week.
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Why can't I snack between meals?
Snacking is the worst thing you can do to your weight loss control process. Snacking, nibbling or grazing on foods can add hundreds of calories a day to your intake. This defeats the restrictive effect of your operation. Since most snacking is done out of impulse, hunger limitations or satiety has a limited effect in preventing it. Snacking will definitely slow down your weight loss and can lead to later regain of weight. Snacking is also a habit, which is easier to avoid than to stop once it is started.
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Why drink so much water?
When you are losing weight, there is a heavy load of waste products to eliminate, mostly in the urine. Some of these substances tend to form crystals, which can cause stones. A high water intake protects you and helps your body rid itself of waste products efficiently, promoting better weight loss. Water will also fill your stomach and will help produce and intensify your sense of satisfaction with food. If you feel a desire to eat between meals, it is because you did not drink enough water in the hour before.
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Why is exercise important?
When you have a gastric bypass, you lose weight because the amount of food energy (calories) eaten is much less than your body needs to operate. It has to make up for the difference by burning reserves or unused tissues. Your body will burn any unused muscle first before it begins to burn the precious fat it has saved up. If you do not exercise daily, your body will consume your unused muscle and you will lose muscle mass and strength. Daily aerobic exercise for 20 minutes will communicate to your body that you want to use and keep your muscles.
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